D Pistolas

Evangelismos Hospital, Athínai, Attica, Greece

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Publications (20)26.7 Total impact

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    ABSTRACT: The purpose of this study is to present the five-year survival and function of the renal allograft of recipients who were diagnosed with BK viremia and viruria during the first year after renal transplantation. BK virus was studied in 32 new renal allograft recipients, from the first postoperative day until 18 months after the transplantation. Real-time polymerase chain reaction was used to detect and quantitate BK viral load in serum and urine samples. Qualitative analysis with PCR for the DNA of BK virus showed 31 (31/228, 14%) positive serum samples originating from 20 (20/32, 62%) renal allograft recipients and 57 (57/228, 25%) positive urine samples originating from 23 (23/32, 72%) recipients. During the follow up period of 5 years, renal allograft function remained stable (eGFR 18(th) month: 53.9 ± 23.9 mL/min/1.73 m(2) and eGFR 5(th) year: 52.6 ± 20.6 mL/min/1.73 m(2)). Comparison of recipients that presented with either BK viremia or viruria with a group that did not present viral reactivation did not reveal a statistically significant difference in eGFR. Furthermore, recipients with significantly high viral load in serum or urine did not present renal allograft dysfunction. BK virus is potentially pathogenic in renal allograft recipients. It is certain that there is a reactivation of the virus in a high percentage of transplanted patients mostly in the first year after the surgery, without however a negative effect of the transient viremia and viruria in renal allograft function.
    Transplantation Proceedings 11/2014; 46(9):3187-90. DOI:10.1016/j.transproceed.2014.10.028 · 0.95 Impact Factor
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    ABSTRACT: Successful outcome of renal transplantation depends on various factors, of which immunologic is one of the most important. Accumulated experience of a single center, with the same surgical and immunological team contributes significantly to safe conclusions. Purpose of this study was the evaluation of potential factors, in particular immunologic, that influence renal allograft survival. During the period 1991-2013, 20,784 surgical operations have been performed in our Department of Surgery - Transplant Unit, of which 575 were renal transplantations. We examined donor and recipient demographic factors, immunologic characteristics along with patient and graft survival. Renal allograft was retrieved from living-related donor in 103 cases and in 472 from cadaveric donor. Donor age was 46.7 ± 18.5 years old and 49.9% (287) were male. Recipient age was 48 ± 12.3 years old and 402 were male. HLA histocompatibility was carefully matched resulting in 85.5% renal transplants with 2-4 HLA mismatches and 93.8% renal transplants with at least one HLA-DR. Renal graft survival the first, fifth and tenth year was 89%, 76%, and 67% and patient survival was respectively 95%, 89% and 83%. Statistical analysis revealed that only donor age influenced renal graft survival (P < .05). HLA mismatches were not correlated with graft survival (log rank P = .495), but identification of panel reactive antibodies (PRA) class I and class II post transplantation had a statistically significant impact on long term renal graft survival (log rank P < .001 and P = .021, accordingly). Analysis of potential prognostic factor showed that only donor age was correlated with allograft survival. Development of PRA following renal transplantation influenced long term graft survival. Good HLA matching with at least one HLA DR resulted in excellent graft and patient survival.
    Transplantation Proceedings 11/2014; 46(9):3175-8. DOI:10.1016/j.transproceed.2014.10.031 · 0.95 Impact Factor
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    ABSTRACT: Transplantation of renal allografts that have been procured from expanded criteria donors (ECD) have prevailed in an attempt to expand the donor pool. Even though ECD is an acceptable source of donors, the wide range of age along with the presence or not of risk factors necessitates further categorization. The aim of this study was to analyze the allograft and recipient survival of the ECD renal grafts and to propose an ECD categorization model. We reviewed the medical records of renal transplant recipients from January 2002 to July 2012, who received renal allografts from expanded and standard criteria donors (SCD) without risk factors such as hypertension, cerebrovascular disease or impaired renal function. During the study period, 310 renal transplantations were performed in our Transplant Unit, of which 86 and 114 renal grafts were procured from ECD and SCD respectively. ECD renal graft survival the first, third and fifth year was 92%, 82% and 70% while respective recipient survival was 95%, 87% and 82%. Comparison with the control group of SCD showed that ECD renal graft survival after the third post-transplant year was significantly inferior (P < .0001). Donor age was a considerable prognostic factor of long-term renal graft function. Serum creatinine of ECD grafts was the first and third year 1.86 ± 0.6 mg/dL and 1.91 ± 0.8 mg/dL, respectively, showing significant difference to that of SCD grafts (P < .0001). Further categorization of ECD showed that renal allografts procured from donors above 60 years old without risk factors had better renal graft survival and function compared to grafts procured from donors aged 50-59 with 2 or 3 risk factors. Renal transplantation from ECD offers acceptable graft survival rates, however they are inferior compared to renal grafts from optimal kidney donors. ECD kidney grafts have to be categorized, taking into consideration the independent risk factors.
    Transplantation Proceedings 11/2014; 46(9):3168-71. DOI:10.1016/j.transproceed.2014.10.029 · 0.95 Impact Factor
  • Hellēnikē cheirourgikē. Acta chirurgica Hellenica 07/2014; 86(4):197-202. DOI:10.1007/s13126-014-0129-6
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    ABSTRACT: Aim: The purpose of the present study was to explore staffing and organisation of nursing care in coronary care units (CCUs) in Greece. Additionally, the frequency at which specific clinical tasks were autonomously performed by nurses was explored, along with the association of organisational and staffing indices with nursing autonomy and continuing education. Material-Method: An exploratory descriptive survey design with additional cross-sectional comparisons was employed. A speci fically developed survey-type questionnaire was distributed to the nurse managers of all CCUs in Greece. The sample comprised 30 CCUs from all over Greece response rate: 67%). Results: Nursing staff per bed ratios over 24 hours (whole-time equivalent: WTE) exhibited a mean of 1.59 (±0.8), ranging from 0.44 to 3.75. The percentage of nursing staff having had participated at training before commencement of work at the CCU was 27.5%; whereas, 33% had participated at in-service continuous education programs. Only in 16.7% of CCUs nurses received CPR training, while only 36.7% of units had established procedure protocols. Nurse per bed ratios associated positively with the percentages of nurses receiving orientation and training (Spearman's rho (rho)=0.372,p=0.04). The frequency at which specific clinical tasks were autonomously performed by nurses exhibited considerable variability, and it was associated with staffing ratios and the percentage of nurses having had received in-service training (p<0.05). Conclusions: In conclusion, staffing and organisation of nursing care in Hellenic coronary care units is characterised by very low nurse per bed ratios, high substitution of RNs by auxiliary personnel, inadequate in-service training, and moderate nursing autonomy in performing technical tasks. Endorsement of nation-wide standards for nursing staffing and training in CCUs is imperative; since they will, presumably, alleviate some of the problems reported herein.
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    ABSTRACT: Laparoscopic surgery has evolved to become a safe alternative to open surgery, minimising hospitalisation and post-operative pain and speeding up recovery. Laparoscopic living donor nephrectomy was successfully introduced to surgical practice and has gained global approval not only because of the considerable advantages to the donor’s health but also because it provides acceptable results of renal graft function. We describe the first laparoscopic living related donor nephrectomy performed in Greece at the Transplant Unit of Evangelismos General Hospital of Athens. KeywordsRenal transplantation-Laparoscopic nephrectomy technique-Living-related donor-Renal allograft-Warm ischemia time-Hand-assisted laparoscopic nephrectomy
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 02/2010; 82(1):16-20. DOI:10.1007/s13126-010-0004-z
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    ABSTRACT: Persistent secondary hyperparathyroidism not responding to medication is treated successfully with surgical excision of parathyroid glands (total parathyroidectomy [PTX]). PTX without autotransplantation of parathyroid glands excludes the risk for recurrence of hyperparathyroidism. During the years 2002 to 2005, 36 total parathyroidectomies were performed in 33 patients: 21 dialysis patients because of end-stage renal disease and 12 renal transplant recipients. PTX without autotransplantation was performed successfully in 33 patients, whereas 3 patients were reoperated for remaining parathyroid glands. Immediate improvement of clinical symptoms and a decrease of serum calcium and parathormone levels were observed after surgical procedures. Oral replacement treatment with vitamin D (1a-calcidiol) and calcium was commenced and long-term follow-up evaluation (23.5 +/- 7.6 mo) showed that calcium homeostasis was controlled adequately. PTX without autotransplantation is a safe and effective surgical procedure for the treatment of resistant secondary hyperparathyroidism with immediate response of clinical symptoms. Replacement treatment with vitamin D and calcium provides satisfactory coverage of individual needs.
    American journal of surgery 03/2009; 198(2):178-83. DOI:10.1016/j.amjsurg.2008.08.017 · 2.41 Impact Factor
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    ABSTRACT: BK virus-associated nephropathy (BKVAN) can be diagnosed only with renal graft biopsy. Definitive diagnosis of BKVAN requires demonstration of BK virus (BKV) replication in renal allograft tissues. Non-invasive analysis of urine and blood is considered essential in screening renal transplant recipients. This study evaluated prospectively the replication of BKV in plasma and urine with qualitative and quantitative real-time polymerase chain reaction in 32 de novo (group A) and 34 chronic (group B) renal transplant recipients and the long-term impact on graft function. In group A, 456 samples (228 plasma, 228 urine) were examined and BKV was detected in 31 (31/228, 14%) samples of plasma and 57 (57/228, 25%) samples of urine in 20 (20/32, 62.5%) and 23 (23/32, 72%) recipients, respectively. Incidence of viremia and viruria increased during the first 6 months presenting a peak the third postoperative month (viremia: 28% and viruria: 31%). Immune suppressive treatment with tacrolimus showed significant relation with viremia. Renal graft function in de novo renal transplant recipients remained stable throughout the follow-up period without influence of BKV replication. In group B, incidence of viremia and viruria were 3% (1/34) and 9% (3/34) correspondingly, indicating that after the first post-transplant year the risk of BKV re-activation is diminished. The highest incidence of BK viremia and viruria is observed the third post-transplantation month, confirming previously published studies in Europe and the United States, and long-term follow up shows that BKV replication decreases significantly after the third post-transplant month and even transient viremia or viruria does not have an impact on renal function.
    Transplant Infectious Disease 10/2008; 11(1):1-10. DOI:10.1111/j.1399-3062.2008.00342.x · 1.98 Impact Factor
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    ABSTRACT: The aim of this study is to explore the quality of life of elderly patients after coronary artery bypass graft (CABG) surgery. The present study employed a pre-post test design. Sixty three elderly patients (>or=65 years), operated in one big general hospital in Athens, were interviewed before, 4 months and 12 months after CABG with the MacNew Heart disease health-related quality of life questionnaire. The majority of the sample were male (N=48, 76.2%), married (N=49, 77.8%) and pensioners (N=54, 61.7%). After the operation and before discharge 42 (66.6%) patients presented complications. One year after the operation, 45 (80.4%) patients experienced improvement and only 11 (19.6%) deterioration in their reported quality of life. Despite this postoperative improvement in all domains, a high percentage of patients (>60%) continued to report exacerbation in questions related to self confidence and dependence to others indicating an overprotective environment. Approximately one in two patients reported signs of cognitive dysfunction during the postoperative period. Elderly patients knew very little about their disease, especially before the operation (mean=2.03, SD=0.69, R=1-5). Educational level, presence of complications in the immediate postoperative period and reported angina were related to a poorer QoL. A high proportion of the patients experienced improvement while a substantial number had exacerbations related to self confidence and dependence to others. An important step to improve this situation might be through the institution of a structured multi-disciplinary rehabilitation program with focus on emotional support, information giving and education to elderly CABG patients and their significant others.
    European Journal of Cardiovascular Nursing 04/2008; 8(1):74-81. DOI:10.1016/j.ejcnurse.2008.02.008 · 1.83 Impact Factor
  • European Journal of Cardiovascular Nursing 03/2008; 7:S22-S23. DOI:10.1016/j.ejcnurse.2008.01.040 · 1.83 Impact Factor
  • Transplantation 01/2008; 86. DOI:10.1097/01.tp.0000331379.17996.99 · 3.78 Impact Factor
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    ABSTRACT: This study was undertaken to compare and to evaluate the health-related quality of life (HRQOL) in Greek adult transplant recipients before and 1 year after successful renal transplantation (RT) and to examine which parameters had the greatest effects on their HRQOL. The SF-36 survey score was used. Eighty-five Greek hemodialysis patients underwent RT at the Transplant Unit of Evangelismos General Hospital of Athens, including 44 men and 41 women (mean age, 43.8 years; range, 21-59 years). Thirty-nine patients had received a kidney from a living-related donor, and 46 from a cadaver. The scale scores of a Greek version of the SF-36 survey were compared between the transplant and the hemodialysis patients. We also examined the relationships of the scale scores with the patients' age and the type of donor. According to the SF-36 health survey, transplant recipients had better results for general health perception (P <or= .001), role-physical functioning (P <or= .01), role-emotional functioning (P <or= .01), and vitality (P < or=.01). In addition, the scale scores of physical functioning, general health, and vitality of the patients who were younger than 30 years old at the time of transplantation were significantly higher than those of the patients who were older than 30 years, while the scores of bodily pain, general health, and physical functioning were significantly lower in cadaveric graft recipients compared with living-related graft recipients. The SF-36 health survey is a validated and comprehensive instrument for evaluating renal transplant patients' HRQOL. Our data demonstrate an improvement in HRQOL in renal transplant patients from before to 1 year after successful RT. The data also confirm that the recipients' age at transplantation and the type of donor were important factors affecting the HRQOL.
    Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 01/2007; 4(2):521-4. · 0.80 Impact Factor
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    ABSTRACT: Gastrointestinal symptoms following cardiac surgery were studied in a sample of 120 patients in tertiary hospital in Athens, Greece. The occurrence of symptoms and the amount of distress they caused was recorded on three occasions: during the stay in hospital, two weeks after discharge and six weeks after discharge. Poor appetite (8.4%) and lack of taste (17.8%) were the commonest symptoms in hospital, and caused the most distress (6.5% and 16.8%, respectively), whereas only 0.9% reported frequent nausea and 1.9% distress. Poor appetite was associated with older age and nausea with mean arterial pressure during surgery. Two weeks after discharge, less than 1% of the sample reported frequent symptoms or a lot of distress and even occasional symptoms had virtually disappeared by six weeks.
    European Journal of Cardiovascular Nursing 03/2005; 4(1):67-67. DOI:10.1177/147451510500400140 · 1.83 Impact Factor
  • Transplantation 01/2004; 78. DOI:10.1097/00007890-200407271-00654 · 3.78 Impact Factor
  • Transplantation 01/2004; 78. DOI:10.1097/00007890-200407271-01993 · 3.78 Impact Factor
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    ABSTRACT: To explore staffing and organisational characteristics of nursing care in cardiac intensive care units (CICUs) in Greece. An exploratory descriptive survey design with additional cross-sectional comparisons was employed. A specifically developed survey-type questionnaire, addressed to nurse managers, was distributed to all CICUs in Greece. The response rate was 76.2% (N=32 units). Nursing staff per bed ratios over 24 h (whole-time equivalent) were very low and exhibited a mean of 1.25 (+/-0.53). The total registered nurse to assistance nurse (RN/AN) ratio was 2.74, but a lot of variability was observed and in many units ANs operated in RNs positions. Only 42% of the nurses had participated at in-service continuing education programs and a systematic training program in cardio pulmonary resuscitation (CPR) was provided in only 12 (37.5%) units. The reported frequencies at which specific technical tasks were performed autonomously by nurses varied substantially and reflected a medium to low level of practice autonomy; the most frequently reported tasks were: peripheral IV line insertion, CPR chest compression, titration of vasoactive drugs and administration of analgesics. Higher percentages of nurses had received in-service training associated with the likelihood of performance of several technical tasks (P<0.03). Future studies need to explore the effect of these organisational characteristics on patient outcomes. The endorsement of nation-wide standards for nursing staffing and training in CICUs is imperative.
    European Journal of Cardiovascular Nursing 08/2003; 2(2):123-9. DOI:10.1016/S1474-5151(03)00029-X · 1.83 Impact Factor
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    ABSTRACT: The aim of this study was to assess the quality of life in elderly patients before and 4 months after coronary artery bypass graft (CABG) operation in order to identify areas for interventions and further improvement of the provided care. This is part of a bigger project to assess the quality of life in CABG patients over time. The collection of data was based on interviews by using the MACNE.W heart disease health-related quality of life questionnaire. The study sample consisted of 120 cardiac artery bypass surgery patients (CABS) (100 men, 20 women) with a mean Age of 63.13 years (±8.55) and an average length of stay 14.2 days (±4.78). There was a significant improvement of the physical (+1.79, P<0.001) and social (+1.57, P<0.001) state of the patients after the operation. The emotional state of the patients showed a very small improvement (+0.56, P=0,001) and the cognitive ability, as it was measured by three questions, showed a decline (-0.51, P<0.001). Patients, 4 months after the operation, exhibited a lower level of self-confidence and were more dependent on others. Sex, age, physical condition before the operation and chest pain were found to be related to the quality of life before and after the operation. The assessment of the quality of life has to be established as an official outcome indicator for the evaluation of therapeutic interventions of cardiac artery disease (CAD) patients. It is imperative that government plan and implement rehabilitation programs in order to cover the individual needs and enhance the quality of life of CABG patients.
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    ABSTRACT: Aim: The aim of this study is to compare the quality of life of coronary artery bypass graft patients before and after the operation. This is a pilot project of a greater research effort whose main aim is to assess the quality of life of those patients over different times after the operation and also to explore the ability of preoperative variables to predict improved outcome. Material - Method: The collection of data was based on interviews with patients before and 4 months after the operation by using the MacNew Heart disease health-related quality of life questionnaire. The study sample consisted of 30 patients (25 men, 5 women) with mean age of 64.8 years (SD=8.54) and average length of stay 15.5 days (SD=5.78). The most frequent risk factors were the lack of exercise (90%) and smoking (66.7%) History of cardiovascular disease was reported by 11 patients (36.7%). Results: There was a significant improvement of the physical (+3.46 - P<0.05) and social (+2.71 - P<0.05) state of the patients after the operation. The emotional state of the patients showed a very small improvement (+0.50 - P=0,16) and the cognitive ability, as it was measured by three questions, showed a decline (0.93 - P<0.001). The internal consistency reliability of the questionnaire ranged from 0.83 to 0.92 for the physical, emotional and social subscales. Conclusions: The results to great degree show that coronary artery bypass surgery enhances the physical and social function of the patients 4 months after the operation but there is a significant need to further explore the effect on the emotional and cognitive state of the patients as well as the possible associated factors.
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    ABSTRACT: Today, in a turbulent and competitive health care environment patients more and more, seek to learn what is happening in their own situation and participate in planning their health care and decision-making. Cardiac surgery patients are discharged earlier and anticipate many problems during the rehabilitation period. Preoperative and postoperative education of the patients is of great importance and patients knowledge of self care after discharge is a main outcome indicator of the quality of the provide services. The aim of this study was to assess cardiac surgery patients’ knowledge of self care after the discharge and explore any correlation with the patient characteristics. The sample consisted of 91 patients who admitted during 3 months in two cardiac surgery wards and had an open-heart operation. A special questionnaire was developed based on four dimensions: general, diet, rest, and drugs. Patients scored higher the diet scale (mean=1,91, SD=0,26, scale 0-2) and lower the drug scale ( mean=0,10, SD=0,4, scale 0-2). The majority of the patients wanted to learn more (98,9%) and nurses had not been involved in the educational process. The analysis of variance revealed an indication of correlation between the educational level and the patients’ knowledge but the small sample does not allow safe conclusions. The results can be used for the planning of the patients’ preoperative and postoperative education.